構音障害改善後に読み書きの問題が顕著になった1症例

A case whose difficulty in reading and writing became evident after his articulation disorder had improved

　構音障害改善後に読み書きの問題が顕著になった1症例の経過を詳細に検討し，その問題点について考察した．

　初期評価の結果，本児は特異性言語発達障害に伴う構音障害と判断された．その後，言語発達の遅れは急速に改善し，再評価時には全般的な知能・言語発達に大きな遅れは認められず，構音障害が主な問題と考えられた．構音の改善を目的に文字導入を試みたが，文字の習得は著しく困難であった．現在では，知能面・認知面の偏りは顕在化し，音韻処理障害も示唆され，発達性読み書き障害と判断された．

　本児の経過は，幼少期に構音障害が目立つ子どものなかに，経過とともに発達性読み書き障害を呈する子どもが存在することを示唆するものと思われた．読み書き障害児の早期発見の重要性を鑑みて，言語聴覚士が早期からその鑑別を視野に入れる必要があると考えられた．その方向性として，音韻処理障害の重症度と読み書きの能力との関連の検討があげられた．

　In this paper, we report a case of developmental dyslexia whose reading and writing difficulties became evident after his articulation disorder had improved.　The child's initial evaluation at the age of 3 years 5 months indicated articulation disorder concomitant with specific language impairment.　The delay in language development improved rapidly, and no significant delays in general intelligence or language development were observed at the time of re-evaluation, leaving the articulation disorder to be the primary problem.　Kana letters were introduced early to help improve the articulation disorder;however, the child had great difficulty learning letters.　At present (second grade), the imbalance in general intelligence and cognition, especially phonological processing disorder, has become more evident, and the case was determined to have developmental dyslexia.　The course of this case indicates that some children with significant articulation disorder in their early childhood may exhibit developmental dyslexia over time.　Considering the importance of early detection of children with dyslexia, it is essential that speech-language-hearing therapists aim at identification at an early stage.　Further investigations into the relationship between the severity of phonological processing disorder and literacy should be carried out in the future.